Drug administration through enteral tubes after gastrointestinal surgery

Authors

DOI:

https://doi.org/10.33448/rsd-v10i5.14927

Keywords:

Pharmaceutical preparations; Enteral nutrition; Drug interactions; Surgical procedures operative; Postoperative care.

Abstract

Patients undergoing gastrointestinal tract operations are complex and often receive medications via enteral tubes (ET). The aim of this study was to analyze the profile of the limitations of administration via SE of medications prescribed to patients undergoing operations on the gastrointestinal tract and abdominal wall and associated factors. To this end, all electronic prescriptions of patients using enteral nutrition (EN) and in the postoperative period at a general university hospital were analyzed (01/05 to 12/05/2017). Medicines prescribed for administration via ET were identified and a literature review about limitations for its administration in this type of tube. The prevalence of these limitations and associated factors was determined through uni (Pearson's chi-square) and multivariate (logistic regression - 5% statistical significance level) analyzes. A total of 341 prescriptions from 40 patients were analyzed. A total of 725 drugs prescribed via ET (44 different drugs) were identified. In the review, 33 articles were retrieved for the construction of a database, which allowed the identification of 188 limitations regarding drug administration via ET. The prevalence of at least one limitation regarding drug administration via ET among the patients evaluated was 57.5% (n = 23), and it was positively associated with age equal to or greater than 60 years (OR 4.67; 95%CI 1.07-20.40). Due to the scarcity of references for medication administration via ET, this study is an important tool for pharmacotherapeutic care for patients using EN. The number of limitations identified was low, but its association with advanced age and the severity of the studied population reinforce the importance of prioritizing its management.

References

Ahn, H. S., Yook, J. H., Park, C. H., Park, Y. K., Yu, W., Lee, M. S., … Yang, H. K. (2011). General perioperative management of gastric cancer patients at high-volume centers. Gastric Cancer, 14(2), 178–182. https://doi.org/10.1007/s10120-011-0012-x

ANVISA. (2013). PROTOCOLO DE SEGURANÇA NA PRESCRIÇÃO, USO E ADMINISTRAÇÃO DE MEDICAMENTOS. Ministério Da Saúde. Retrieved from https://www20.anvisa.gov.br/segurancadopaciente/index.php/publicacoes/item/seguranca-na-prescricao-uso-e-administracao-de-medicamentos

Boullata, J. I. (2009). Drug Administration Through an Enteral Feeding Tube. AJN, 109(10), 34–42. https://doi.org/10.1007/978-3-319-10386-0

Boullata, J. I., & Armenti, V. T. (2010). Handbook of Drug–Nutrient Interactions.

Bourgault, A. M., Ipe, L., Weaver, J., Swartz, S., & J. O’Dea, P. (2007). Development of Evidence-Based Guidelines and Critical Care Nurses ’ Knowledge of Enteral Feeding. American Association of Critical-Care Nurses, 27, 17–29.

Carvalho, A. M. R., Oliveira, D. C., Neto, J. E. D. H., Martins, B. C. C., Vieira, V. M. D. S. F., Silva, L. I. M. M. Da, … Marta Maria de F. Fonteles1, 3, 4. (2010). Análise da prescrição de pacientes utilizando sonda enteral em um hospital universitário do Ceará. Revista Brasileira Farmácia Hospitalar e Serviços de Saúde, 1(1), 17–21.

Decloedt, E., & Maartens, G. (2009). Pitfalls of administering drugs via nasogastric tubes. SAMJ Forum, 99.

Dickerson, R. N. (2008). Warfarin resistance and enteral tube feeding: A vitamin K-independent interaction. Nutrition, 24(10), 1048–1052. https://doi.org/10.1016/j.nut.2008.05.015

Dickerson, R. N., Garmon, W. M., Kuhl, D. A., Minard, G., & Brown, R. O. (2008). Vitamin K - Independent warfarin resistance after concurrent administration of warfarin and continuous enteral nutrition. Pharmacotherapy, 28(3), 308–313. Retrieved from http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L351328903%5Cnhttp://dx.doi.org/10.1592/phco.28.3.308%5Cnhttp://zp9vv3zm2k.search.serialssolutions.com/?sid=EMBASE&issn=02770008&id=doi:10.1592%2Fphco.28.3.308&atitle=Vitamin+K+-+Ind

DRUG-REAX®. (2018). IBM Micromedex. Retrieved October 1, 2018, from http://www.micromedexsolutions.com/

Gorzoni, M. L., Torre Della, A., & Pires, S. L. (2010). Drugs and feeding tubes. Revista Da Associacao Medica Brasileira, 56(1), 17–21.

Guenter, P., & Boullata, J. (2013). Drug administration by enteral. Nursing2013, 27–33.

Heineck, I., Bueno, D., & Heydrich, J. (2009). Study on the use of drugs in patients with enteral feeding tubes. Pharmacy World and Science, 31(2), 145–148. https://doi.org/10.1007/s11096-008-9268-6

Heldt, T., & Loss, S. H. (2013). Drug-nutrient interactions in the intensive care unit: Literature review and current recommendations. Revista Brasileira de Terapia Intensiva, 25(2), 162–167. https://doi.org/10.5935/0103-507X.20130028

Huang, D., Sun, Z., Huang, J., & Shen, Z. (2015). Early enteral nutrition in combination with parenteral nutrition in elderly patients after surgery due to gastrointestinal cancer. International Journal of Clinical and Experimental Medicine, 8(8), 13937–13945.

Hyde, L. Z., Al-Mazrou, A. M., Kuritzkes, B. A., Suradkar, K., Valizadeh, N., & Kiran, R. P. (2018). Readmissions after colorectal surgery: not all are equal. International Journal of Colorectal Disease, 33(12), 1667–1674. https://doi.org/10.1007/s00384-018-3150-3

Jack, L., Coyer, F., Courtney, M., & Venkatesh, B. (2010). Diarrhoea risk factors in enterally tube fed critically ill patients: A retrospective audit. Intensive and Critical Care Nursing, 26(6), 327–334. https://doi.org/10.1016/j.iccn.2010.08.001

Jansen, P. A. F., & Brouwers, J. R. B. J. (2012). Clinical Pharmacology in Old Persons. Scientifica, 2012, 1–17. https://doi.org/10.6064/2012/723678

Johnson, C. E., Cober, M. P., & Ludwig, J. L. (2007). Stability of partial doses of omeprazole-sodium bicarbonate oral suspension. Annals of Pharmacotherapy, 41(12), 1954–1961. https://doi.org/10.1345/aph.1K246

Joos, E., Mehuys, E., Van Bocxlaer, J., Remon, J. P., Van Winckel, M., & Boussery, K. (2015). Drug administration via enteral feeding tubes in residential care facilities for individuals with intellectual disability: An observational study. Journal of Intellectual Disability Research, 59(3), 215–225. https://doi.org/10.1111/jir.12129

Joos, Elke, Mehuys, E., Remon, J. P., Van Winckel, M., & Boussery, K. (2016). Analysis of drug use in institutionalized individuals with intellectual disability and tube feeding. Acta Clinica Belgica: International Journal of Clinical and Laboratory Medicine, 71(2), 76–80. https://doi.org/10.1080/17843286.2015.1122332

Joos, Elke, Verbeke, S., Mehuys, E., Van Bocxlaer, J., Remon, J. P., Van Winckel, M., & Boussery, K. (2016). Medication administration via enteral feeding tube: a survey of pharmacists’ knowledge. International Journal of Clinical Pharmacy, 38(1), 10–15. https://doi.org/10.1007/s11096-015-0196-y

Jory, C., Shankar, R., Oak, K., Oates, J., & Wilcock, M. (2017). Going down the tubes! Impact on seizure control of antiepileptic medication given via percutaneous feeding tubes. Epilepsy and Behavior, 74, 114–118. https://doi.org/10.1016/j.yebeh.2017.06.024

Kappelle, W. F. W., Siersema, P. D., Bogte, A., & Vleggaar, F. P. (2016). Challenges in oral drug delivery in patients with esophageal dysphagia. Expert Opinion on Drug Delivery, 13(5), 645–658. https://doi.org/10.1517/17425247.2016.1142971

Kelly, J., Wright, D., & Wood, J. (2011). Medicine administration errors in patients with dysphagia in secondary care: A multi-centre observational study. Journal of Advanced Nursing, 67(12), 2615–2627. https://doi.org/10.1111/j.1365-2648.2011.05700.x

Klang, M., McLymont, V., & Ng, N. (2013). Osmolality, pH, and compatibility of selected oral liquid medications with an enteral nutrition product. Journal of Parenteral and Enteral Nutrition, 37(5), 689–694. https://doi.org/10.1177/0148607112471560

Kozeniecki, M., & Fritzshall, R. (2015). Enteral Nutrition for Adults in the Hospital Setting. Nutrition in Clinical Practice, 30(5), 634–651. https://doi.org/10.1177/0884533615594012

Krajewski, K. C., & Butterfoss, K. (2011). Achievement of therapeutic international normalized ratio following adjustment of tube feeds. Journal of Clinical Pharmacology, 51(3), 440–443. https://doi.org/10.1177/0091270010374469

Kurien, M., Penny, H., & Sanders, D. S. (2015). Impact of direct drug delivery via gastric access devices. Expert Opinion on Drug Delivery, 12(3), 455–463. https://doi.org/10.1517/17425247.2015.966683

Lewis, S. J., Andersen, H. K., & Thomas, S. (2009). Early enteral nutrition within 24 h of intestinal surgery versus later commencement of feeding: A systematic review and meta-analysis. Journal of Gastrointestinal Surgery, 13(3), 569–575. https://doi.org/10.1007/s11605-008-0592-x

Lonergan, M. T., Broderick, J., Coughlan, T., Collins, D. R., & Neill, D. O. (2009). Prescribing and enteral tubes in the general hospital. JAGS, 57(4), 736–737.

Lubart, E., Berkovitch, M., Leibovitz, A., Britzi, M., Soback, S., Bukasov, Y., & Segal, R. (2013). Pharmacokinetics of ciprofloxacin in hospitalized geriatric patients: Comparison between nasogastric tube and oral administration. Therapeutic Drug Monitoring, 35(5), 653–656. https://doi.org/10.1097/FTD.0b013e3182940426

Manessis, A., Lascher, S., Bukberg, P., Darmody, T., & Y, V. (2008). Quantifying Amount of Adsorption of Levothyroxine by Percutaneous Endoscopic ... Source, 197–200.

Martins, M. R., Soares, A. Q., Modesto, A. C. F., Carvalho, R. F., Melo, V. V. de, & Duarte, I. de P. (2013). Análise de medicamentos administrados por sonda em unidades de terapia intensiva em hospital de ensino. Revista Eletrônica de Enfermagem, 15(1), 191–196. https://doi.org/10.5216/ree.v15i1.15848

Mcintyre, C. M., & Monk, H. M. (2014). Medication absorption considerations in patients with postpyloric enteral feeding tubes. American Journal of Health-System Pharmacy, 71(7), 549–556. https://doi.org/10.2146/ajhp130597

Miasso, A. I., & Cassiani, S. H. (2000). Erros na administração de medicamentos: divulgação de conhecimentos e identificação do paciente como aspectos relevantes. Revista Da Escola de Enfermagem Da U S P, 34(1), 16–25.

Miller, K. R., McClave, S. A., Kiraly, L. N., Martindale, R. G., & Benns, M. V. (2014). A tutorial on enteral access in adult patients in the hospitalized setting. Journal of Parenteral and Enteral Nutrition, 38(3), 282–295. https://doi.org/10.1177/0148607114522487

Mink, S., Muroi, C., Seule, M., Bjeljac, M., & Keller, E. (2011). Levetiracetam compared to valproic acid: Plasma concentration levels, adverse effects and interactions in aneurysmal subarachnoid hemorrhage. Clinical Neurology and Neurosurgery, 113(8), 644–648. https://doi.org/10.1016/j.clineuro.2011.05.007

Nascimento, M. M. G. Do, & Ribeiro, A. Q. (2010). Compilação de base de dados com recomendações para administração de medicamentos via sonda enteral. Rev. Bras. Farm. Hosp. Serv. Saúde, 1(1), 22–25.

Oliveira, R. S., Santos, S. R., Rezende, C. P., & Nascimento, M. M. G. (2020). Recomendações para o preparo e administração de medicamentos via cateter enteral : uma revisão. Journal of Applied Pharmaceutical Sciences, (7), 88–98.

Phillips, Nicole M., & Nay, R. (2008). A systematic review of nursing administration of medication via enteral tubes in adults. Journal of Clinical Nursing, 17(17), 2257–2265. https://doi.org/10.1111/j.1365-2702.2008.02407.x

Phillips, Nicole Margaret, & Endacott, R. (2011). Medication administration via enteral tubes: A survey of nurses’ practices. Journal of Advanced Nursing, 67(12), 2586–2592. https://doi.org/10.1111/j.1365-2648.2011.05688.x

Reis, A. M. M., Carvalho, R. E. F. L. de, Faria, L. M. P. de, Oliveira, R. C. de, Zago, K. S. de A., Cavelagna, M. F., … Cassiani, S. H. de B. (2014). Prevalence and clinical significance of interactions drug-enteral nutrition in Intensive Care Units. Revista Brasileira de Enfermagem, 67(1), 85–90. https://doi.org/10.5935/0034-7167.20140011

Reis, A. M. M., & Cassiani, S. H. D. B. (2011). Prevalence of potential drug interactions in patients in an intensive care unit of a university hospital in Brazil. Clinics, 66(1), 9–15. https://doi.org/10.1590/s1807-59322011000100003

Reis, V. G. do O., Candido, M. F., Jesus, R. P. de, & Mendes-Netto, R. S. (2010). Profile of the Use of Drugs Administered Via Enteral. Revista Chil Nutr, 37(3), 293–301.

Renovato, R. D., de Carvalho, P. D., & Rocha, R. dos S. A. (2010). Investigação da técnica de administração de medicamentos por sondas enterais em hospital geral. Revista Enfermagem UERJ, 18(2), 173–178.

Shi, S., & Klotz, U. (2011). Age-related changes in pharmacokinetics. Current Drug Metabolism, 12(7), 601–610. https://doi.org/10.2174/138920011796504527

Silva, L. D. da, Schutz, V., Praça, B. F. M., & Santos, M. E. R. dos. (2010). Interação fármaco-nutrição enteral: uma revisão para fundamentar o cuidado prestado pelo enfermeiro. Revista Enfermagem UERJ, 18(2), 304–310.

Silva, M. F. B. da, Brito, P. D. de, & Guaraldo, L. (2016). Medicamentos orais de uma unidade hospitalar: adequação ao uso por cateteres enterais. Revista Brasileira de Enfermagem, 69(5), 847–854. https://doi.org/10.1590/0034-7167-2015-0081

Silva, M. J. S. da, Cava, C. E. M., Pedroso, P. K., & Futuro, D. O. (2011). Evaluation of the profile of drug therapy administered through enteral feeding tube in a general hospital in Rio de Janeiro. Brazilian Journal of Pharmaceutical Sciences, 47(2), 331–337. https://doi.org/10.1590/S1984-82502011000200014

Silva, L. D., & Lisboa, C. D. D. (2011). Consequências Da Interação Entre Nutrição Enteral E Fármacos Administrados Por Sondas : Uma Revisão Integrativa *. Cogitare Enferm., 16(1), 134–140.

Tisdale, J. E., Wroblewski, H. A., Hammoud, Z. T., Rieger, K. M., Young, J. V., Wall, D. S., & Kesler, K. A. (2007). Prospective evaluation of serum amiodarone concentrations when administered via a nasogastric tube into the stomach conduit after transthoracic esophagectomy. Clinical Therapeutics, 29(10), 2226–2234. https://doi.org/10.1016/j.clinthera.2007.10.002

Wheble, G. A. C., Knight, W. R., & Khan, O. A. (2012). Enteral vs total parenteral nutrition following major upper gastrointestinal surgery. International Journal of Surgery, 10(4), 194–197. https://doi.org/10.1016/j.ijsu.2012.02.015

Williams, N. T. (2008). Medication administration through enteral feeding tubes. American Journal of Health-System Pharmacy, 65(24), 2347–2357. https://doi.org/10.2146/ajhp080155

Wilson, N., & Best, C. (2011). Administration of medicines via an enteral feed tube. Nursing Times, 107(41), 18–20. Retrieved from http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L366367912%5Cnhttp://zp9vv3zm2k.search.serialssolutions.com/?sid=EMBASE&issn=09547762&id=doi:&atitle=Administration+of+medicines+via+an+enteral+feed+tube.&stitle=Nurs+Times&title=Nur

Wu, X., Jiang, Z., Ying, J., Han, Y., & Chen, Z. (2017). Optimal blood pressure decreases acute kidney injury after gastrointestinal surgery in elderly hypertensive patients: A randomized study: Optimal blood pressure reduces acute kidney injury. Journal of Clinical Anesthesia, 43, 77–83. https://doi.org/10.1016/j.jclinane.2017.09.004

Zhao, X. F., Wu, N., Zhao, G. Q., Liu, J. F., & Dai, Y. F. (2016). Enteral nutrition versus parenteral nutrition after major abdominal surgery in patients with gastrointestinal cancer: A systematic review and meta-analysis. Journal of Investigative Medicine, 64(5), 1061–1074. https://doi.org/10.1136/jim-2016-000083

Zhuang, C. Le, Ye, X. Z., Zhang, C. J., Dong, Q. T., Chen, B. C., & Yu, Z. (2013). Early versus traditional postoperative oral feeding in patients undergoing elective colorectal surgery: A meta-analysis of randomized clinical trials. Digestive Surgery, 30(3), 225–232. https://doi.org/10.1159/000353136

Published

09/05/2021

How to Cite

SANTOS, S. R. dos; ARAÚJO, R. L. B. de; REZENDE, C. de P.; NASCIMENTO, M. M. G. do. Drug administration through enteral tubes after gastrointestinal surgery. Research, Society and Development, [S. l.], v. 10, n. 5, p. e33310514927, 2021. DOI: 10.33448/rsd-v10i5.14927. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/14927. Acesso em: 23 apr. 2024.

Issue

Section

Health Sciences